1/9. sleep disorders in children and teens. Helping patients and their families get some rest.Diagnosing sleep disorders in children and adolescents is challenging and rewarding and requires integration of medical, neurodevelopmental, and behavioral histories. Most patients can be successfully treated once a thorough evaluation has been completed and age-appropriate differential diagnosis of common sleep disorders has been considered. With appropriate knowledge and tools, physicians may find that pediatric sleep disorders are some of the most treatable problems in medicine.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/9. Sleep-wake schedule disorder disability: a lifelong untreatable pathology of the circadian time structure.Certain sleep-wake schedule disorders (SWSDs) cannot be successfully managed clinically using conventional methods of sleep therapy. We describe two cases of SWSD, the first following head trauma and the second originating during childhood, that had been misdiagnosed by physicians for many years. After conventional treatment for SWSD with light therapy and melatonin failed to bring about substantial improvement, it was determined that they were suffering from an incurable disability. Hence, we propose new medical terminology for such cases--SWSD disability. SWSD disability is an untreatable pathology of the circadian time structure. patients suffering from SWSD disability should be encouraged to accept the fact that they suffer from a permanent disability, and that their quality of life can only be improved if they are willing to undergo rehabilitation. It is imperative that physicians recognize the medical condition of SWSD disability in their patients and bring it to the notice of the public institutions responsible for vocational and social rehabilitation.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
3/9. sleep disorders.humans spend approximately one third of their lives asleep. Although the same medical disorders that occur during wakefulness persist into sleep, there are many disorders that occur exclusively during sleep or are manifestations of a disturbance of normal sleep-wake physiology. The most common reason for referral to a sleep laboratory is OSA, whereas the most common sleep disorder is insomnia. Effective treatments now exist for many sleep disorders, such as OSA and RLS, and a major breakthrough in the treatment of narcolepsy seems imminent. Because all disease processes are adversely affected by insufficient sleep, it is essential that the practicing physician understand the causes and treatments of the common sleep disorders.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/9. Treatment of bipolar, seizure, and sleep disorders and migraine headaches utilizing a chiropractic technique.OBJECTIVE: To discuss the use of an upper cervical technique in the case of a 23-year-old male patient with rapid-cycling bipolar disorder, sleep disorder, seizure disorder, neck and back pain, and migraine headaches. CLINICAL FEATURES: The patient participated in a high school track meet at age 17, landing on his head from a height of 10 ft while attempting a pole vault. Prior to the accident, no health problems were reported. Following the accident, the patient developed numerous neurological disorders. Symptoms persisted over the next 6 years, during which time the patient sought treatment from many physicians and other health care practitioners. INTERVENTION AND OUTCOME: At initial examination, evidence of a subluxation stemming from the upper cervical spine was found through thermography and radiography. chiropractic care using an upper cervical technique was administered to correct and stabilize the patient's upper neck injury. Assessments at baseline, 2 months, and 4 months were conducted by the patient's neurologist. After 1 month of care, the patient reported an absence of seizures and manic episodes and improved sleep patterns. After 4 months of care, seizures and manic episodes remained absent and migraine headaches were reduced from 3 per week to 2 per month. After 7 months of care, the patient reported the complete absence of symptoms. Eighteen months later, the patient remains asymptomatic. CONCLUSION: The onset of the symptoms following the patient's accident, the immediate reduction in symptoms correlating with the initiation of care, and the complete absence of all symptoms within 7 months of care suggest a link between the patient's headfirst fall, the upper cervical subluxation, and his neurological conditions. Further investigation into upper cervical trauma as a contributing factor to bipolar disorder, sleep disorder, seizure disorder, and migraine headaches should be pursued.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/9. bulimia: the binge eating syndrome.bulimia occurs in roughly half of obese and anorexic patients. A recent study found 19% of female and 5% of male college students to be bulimic. Binge eating usually comes to the physician's attention from problems associated with purging measures--diuretics, laxatives, or self-induced postprandial vomiting--used by one out of ten bulimic patients. Continuous vomiting causes parotid enlargement, sore throat, spontaneous regurgitation, and severe electrolyte imbalance. We report a case illustrating the bulimic's distorted body image, review alternative treatment methods, and suggest needed areas of research, particularly those elucidating the relationship between bulimia and affective disorders.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/9. Absence spells. hyperventilation syndrome as a previously unrecognized cause.Absence spells in adults have been recognized in association with disorders of excessive somnolence, transient ischemia of the temporal lobes, and seizure disorders. A 66-year-old man who presented with a history of absence spells for more than 20 years is described. After diagnosis of a hyperventilation syndrome without an associated seizure disorder, educational and behavioral therapy without the use of medication has produced a long, continuing remission of these spells. The hyperventilation syndrome continues to present in many ways, often without recognition by physicians for prolonged periods. The case presented exemplifies this problem and may be the first report of absence spells caused by hyperventilation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/9. Sleep disturbances in the demented elderly: treatment in ambulatory care.We report the results of a representative survey in Lower Saxony, germany, that focused on the treatment of sleep disturbances in the moderately demented elderly. Two written sample case histories (vignettes) described either a vascular demented patient suffering from nocturnal wandering or an Alzheimer's-type demented patient without apparent psychotic or behavioral (sleep) disorder. These were randomly assigned and presented to 145 family physicians and 14 neuropsychiatrists working in private practice by a trained investigator, who then conducted a standardized interview with the physicians. The study was representative of physicians (response rate: 83.2%). In response to the question concerning how they would treat the patient's sleep disturbances, about 20% of the physicians (with respect to both versions) answered that they would not choose drugs. More than 40% considered neuroleptics to be the drugs of choice. benzodiazepines, antidepressants and other substances were seldom considered. No significant difference was noted in the response to the two different case histories. The results allow for the conclusion that non-drug treatments, which (at least initially) should be the treatment of choice, are mainly disregarded by the majority of the ambulatory care physicians. The reason for this seems to be a lack of education in sleep medicine and also in geriatric medicine.- - - - - - - - - - ranking = 5keywords = physician (Clic here for more details about this article) |
8/9. Periodic limb movements of sleep and the restless legs syndrome.Periodic limb movements of sleep and the restless legs syndrome are not diagnoses but rather an indication that there is some CNS disturbance and are associated with an ever-growing number of conditions. They are very common, exist in many forms and are often overlooked by physicians. It is the author's opinion that they are parts of what has been called an akathisia syndrome in the most severe situations and may include the same mechanisms that underlie attention disorders, chronic fatigue syndrome and "sun-downing." They are likely parts of a syndrome caused by dysfunction in a complex brainstem center. This center's normal function is to maintain a smooth electrical template on which discrete neuronal impulses sculpture the rich repertoire we recognize as sensory and motor function awake and to effect a smooth "switching" mechanism allowing sleep to occur without motor and sensory input invading consciousness (awakening). While the DA-ergic CNS pathways have been thought to be the primary neurotransmitter involved, the opioids secondary, there is mounting evidence that the situation is far more complicated, that many neurotransmitter, including stimulating and inhibiting amino acids, play a part. These patients agonize with their indisposition but can be helped by various treatments. Treatment alleviates not only the distress caused by the symptoms but also the devastating insomnia and excessive daytime sleepiness associated with it.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/9. Diencephalic tumours presenting as behavioural problems in the workplace.Two patients presented with histories of significant behavioural disturbance and deteriorated work performance. Subsequent investigations confirmed the presence of a craniopharyngioma and a prolactinoma. Occupational physicians should consider excluding organic pathology in employees with histories of an unexplained marked change in work performance and behaviour.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |